Why do so many great physicians write books at the end of their careers about the essence of doctoring rather than about their achievements in science? This question recurred as I read this collection of essays by Eugene A. Stead, Jr., who was Chairman of Medicine at Duke University from 1947 to 1967. The collection was edited by Barton F. Haynes, the current Chairman.

Many current observers attribute the loss of traditional values of doctoring to the restrictions of managed care, but Dr. Stead saw the early symptoms of this progressive disease much earlier. His essays, the first of which dates from 1953, attribute loss of caring to the misconception that the point of medicine was only to apply the correct science and technology pertaining to the treatment of disease. Medical education and training encouraged this view. As a result, behaviors and skills of caring were lost.

Managed care acknowledges that our resources for health care are finite. Given this reality, it is unethical not to manage care. Successful health care organizations will be those that are effective stewards of resources and that satisfy patients. Satisfaction is nothing more than a person's judgment that he or she has been recognized as unique biology and brain (to use Dr. Stead's distinctions), that his or her hopes and fears have been named, and that these hopes and fears will be addressed in a committed and trusting relationship with a physician. Patient satisfaction and the traditions of caring are synonymous in action. More importantly, producing patient satisfaction is linked to physician satisfaction.

This is what Dr. Stead notes again and again. He writes that education must produce thinkers, that practice must focus on the unique person, that respect is based on a solid grounding in the biology of the brain, that all students and residents need mentors and role models, and that every physician must spend some time each week engaged in teaching rather than in production.

Dr. Stead answered my question. "The future of medicine belongs to those ... health care providers who, in spite of bureaucratic systems, prejudice, and financial disincentives to spend time with patients, continue to care for their patients as human beings ..." Read Dr. Stead's Primer and get back to basics!